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Pots And Reduced Valsalva Ratio?


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I met with my doctor last week, but wasn't able to go over this, and won't see him again for a while (he is an ANS specialist). I know he was very surprised by my testing results, since I believe it's typical for POTS patients to have a normal to increased Valsalva ratio/Phase IV overshoot, but I had a decreased ratio, and a normal Phase IV, though my TTT seemed to show florid POTS. The QSART results also showed that I had neuropathy. at first he seemed to think there may be something more serious going on, but other test results seemed to more-or-less rule this out. I'm very foggy right now, so I'm just posting the findings - does anyone have any ideas as to what my Valsalva results mean, in the context of the other results, or why the test results don't quite match up with one another? Also, what does it mean to have cardiac cholinergic impairment?

Valsalva ratio: 1.26 (Female reference: 1.51-2.65)

Deep breating: 12 (reference: 10-33)


supine: 141/95, hr 97

1 min tilt: 148/96, hr 131

5 min tilt: 132/92, hr 133

10 min tilt: 142/100, hr 136

(my blood pressure was unusually high throughout the testing - usually it runs more like 120/80, and my supine heart rate is usually around 75-90)

Comment: "Heart rate responses to deep breathing were normal. Heart rate responses to Valsalva maneuver were mildly reduced. Blood pressure responses during Valsalva maneuver showed moderate reduced phase II and normal phase IV. Blood pressure was stable during the tilt. Blood flow in the left MCA was stable during the tilt. CO2 level and respiration was normal during the tilt test. Heart rate responses to tilt were exacerbated, maximal heart rate was 155 bpm. The sweat output was normal at forearm, borderline at distal leg, and reduced at proximal leg and at foot. Skin biopsy did show normal epidermal nerve density at both thigh and ankle."

Conclusion: "Abnormal study. There was evidence of moderate vasomotor adrenergic, mild cardiac cholinergic and moderate to severe sudomotor impairment. There was also evidence of severe orthostatic intolerance during the tilt. These findings can be seen in a moderate autonomic neuropathy predominantly affecting sympathetic fibers associated with orthostatic intolerance."

I did tolerate the tilt better than I expected, and didn't start to feel really crappy till the last half-minute, or so :blink:. I tend to have a delayed drop in blood pressure after standing for some time, or even sitting for a very long time - I often go down to 70-something/40-something, and probably lower, though by that point my monitor ceases to give me readings, and I usually need to lay down to keep from passing out.

Oh, and I don't know if this could be a confounding factor, but it seems that I may also have EDS III (according to a geneticist and rheumatologist I recently saw). If I may have some vascular involvement from it, on top of the neuropathy, could that help explain anything?

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